Metabolic Health Matters: On Achieving A Healthy Weight Loss Goal With Dr. Courtney Younglove

 

Watch the episode here

 

Losing weight can seem like a very elusive health goal. We try on so many diets only to yo-yo back again. What really can help us lose weight? What can treat obesity? Dr. Courtney Younglove says, “If we’re going to treat obesity, we all have to treat metabolic health.” Dr. Younglove is a physician, board-certified in Obesity Medicine and Obstetrics & Gynecology. In this episode, she dives deep into health goal achievement as it relates to weight loss and metabolic health, providing us with great information about the factors that keep us from shedding excess weight and how we can overcome them. Join Dr. Younglove today as she uncovers key strategies for achieving sustainable weight loss and a healthier life.

Key takeaways from this episode:

• Treating obesity by treating metabolic health
• Fixing insulin resistance for achieving weight loss
• Great health habits to incorporate into your lifestyle
• You are what your food eats
• Are anti-obesity medications effective?

Guest Social Links:

Heartland Weight Loss Website: https://www.HeartlandWeightLoss.com

Journeys Metabolic Website: https://www.JourneysMetabolic.com

Instagram: https://www.instagram.com/heartlandweightloss/

Facebook: https://www.facebook.com/heartlandweight

LinkedIn: https://www.linkedin.com/in/courtneyyounglove/

YouTube: https://www.youtube.com/channel/UCWhPxCBlpi7_fsCNxb6j1fA

---

Metabolic Health Matters: On Achieving A Healthy Weight Loss Goal With Dr. Courtney Younglove

In this episode, we're going to step into a deeper discussion about health and goal achievement as it relates to weight loss and in particular, metabolic health. To offer us her perspective and support our shared learning, I'm joined by Dr. Courtney Younglove. Dr. Courtney Younglove is a physician who's board-certified in Obesity Medicine and Obstetrics and Gynecology as well. She's been practicing clinical medicine for many years and earned a fellowship from the Obesity Medicine Association back in 2021. This is one of the highest honors bestowed upon members who demonstrate dedication and commitment to the clinical treatment of obesity and obesity-related diseases. We couldn't be joined by anyone better for this discussion.

Beyond that, she's the Founder and Medical Director of Heartland Weight Loss. This is an insurance-based obesity medicine practice with clinics in Overland Park, Kansas, and also Lawrence, Kansas. If you're in Kansas, please look her up. She became the Chief Medical Officer of Journey's Metabolic. This is a solution for tackling our metabolic health crises at scale. She's also the Founder of Well Me, a point solution that brings obesity medicine directly to employers.

Before I bring her up, remember that this show is offered as a resource to educate, inform, and even entertain. It is not intended to treat, diagnose, or cure any ailments. There is no patient-provider relationship established between me, your host, or our guests like Dr. Courtney Younglove. With that out of our way, let's bring her right up and get to this discussion.

‐‐‐

Dr. Courtney Younglove, welcome to the show.

Thanks for having me.

I know I will falter on this but can I call you Courtney?

Yes. That's my name.

Before we dig into this topic, I'd like to hear a bit about your backstory and what brought you to this moment.

It's a story. I went into medicine because I loved the field of medicine and ended up choosing obstetrics and gynecology because it gave me a nice balance between surgical interventions and long-term patient care. There was a lot of variety there. I loved it. It was a great field. I entered that field in the late ‘90s right as this obesity epidemic was taking off. Over the course of my obstetrics and gynecology career, I watched patients getting sicker and sicker. It felt like we were on this rollercoaster that we couldn't get off. Patients kept asking me for help and I lifted my hands. I didn't know what to tell them. It hadn't been a part of my training. I was struggling with my health at the time.

Sitting there, I felt helpless. I went to a conference somewhere in Arizona back then run by the Obesity Medicine Association, thinking maybe I'd get something I could use to help my patients because the biggest concern that people kept bringing me was excess weight. It seemed to revolve around that. As I put my toe in that water, I started to realize that was a whole field of medicine that I didn't even know existed and it seemed to be a decent path to learning how I could help patients.

I went down that path. It took a few years to get board-certified there. I started trying to wrap my head around that practice of medicine and integrate that into a gynecologic obstetric field, which was much more complicated than I could ever realize. During that path, I also started realizing that weight was also a secondary concern. There was something upstream from weight that needed to be addressed as well, which led me down the path of metabolic health. I go down rabbit holes pretty easily.

I eventually decided that nobody was tackling this metabolic problem so I opened up a clinic. I gave my notice to my obstetrics gynecology group and said, "I'm starting a practice," and did it, which was in hindsight insane. I felt called to do it and it needed to be done. It then took off. I am a consummate learner. Being in that obesity medicine space through all of these years of chaos that has erupted has been very exciting and overwhelming. It's honed me on that path that if we're going to treat obesity, which is a passion of mine, we also have to treat metabolic health. It keeps evolving.

To your point, coming from the OB-GYN path makes a lot of sense in certain stripes too because so often women gain weight around their pregnancy, and then have another pregnancy and another pregnancy. It then becomes harder and harder to keep it off. I found I couldn't lose the baby weight until I stopped breastfeeding. My first child, I had breastfed until he was almost two. It was a lot of extra time to keep extra weight on.

To sit in that space. We get used to it, and then you have another baby potentially, and then you have another baby, and then you're so busy raising children that tending to your health becomes not a priority. You then go into menopause. That's another hammer that gets pounded on women. It's a series of events that makes it so hard for women.

The thing that troubles me about this too is we get used to it and then we get acclimated to this idea that it's normal. You are in the center of the country and I've traveled through Kansas a few times. As I travel through the Middle States, I often say, "There are a lot more obese people here." Being somebody who's in the San Francisco Bay Area, where activity is much more common and we don't have the long winters, I can go running any day of the year, year-round, and find somewhere comfortable to do so here, unless it's dumping sheets of rain.

We add to that seasonality where there are times it's harder to be as active or you do have not as good of access to healthy foods. These insults keep compounding. I don't think it's an accident that you have your clinic thriving in Kansas is what I'm getting at here. It also, to me, is something that is insane that we've accepted this as the new normal.

It's even worse in the South than it is in the Midwest but it's bad in the Midwest. It's very culturally acceptable to have excess weight and chronic disease too. That's where I want to shake my head. It's not normal to have hypertension, Type 2 diabetes, pre-diabetes, or fatty liver but we've normalized it, which is hard. We've created a story as a country that this is a genetic problem. Therefore, it's inevitable that I'm going to get these things including excess weight which makes it even harder to fight that process.

This gets to the crux of a conversation that's uncomfortable to have in the present culture world too because, at the same time, we have this movement towards body positivity and self-acceptance. Love the skin you're in, which doesn't necessarily mean you shouldn't seek to also improve and achieve health goals. These two things sometimes lie in conflict. When you're talking about something like, "Yes, and we want to help you achieve your health goals Yes, and we want you to feel comfortable in the shoes you're walking in. You shouldn't have pain walking because you're carrying extra weight." It's uncomfortable.

Two things can be true. Bodies are beautiful. You can be beautiful at any size but not necessarily healthy at any size, if that makes sense. One of the better stories is unhealthy at any size is this idea that if someone has a normal weight, they are healthy. That does not mean that at all. Most of us who have a normal weight are still unhealthy. We just don't have that obvious manifestation of disease visible to the person standing next to us in the checkout line. One of the sad parts of obesity is it's visible right there. The other manifestations of poor health, that 93% of us have at least one of them, those other ones are hidden. It doesn't mean we're healthy if we're small. It doesn't mean we're not beautiful if we're big. Beauty and health are two very different things.

Given that you have been so deeply connected to thousands of patients who want more than anything to lose weight most of the time. Sometimes they want to improve their health and they could even be underweight. There are millions of people who are suffering this way. What do you think it will take? Why do you think they're struggling to achieve this so much? Is there something common and evident to you?

Individually, patients want things so badly. There's so much desire, grit, goals, and strength there. Our cultural environment is like gravity. It pulls everybody right back down again. It's like trying to tell people not to breathe. You can hold your breath for a while but then that overwhelming drive pulls you back down again. For most of us, we're immersed in this weight-positive world where everyone around us is like a school of fish that is moving.

It's hard to stop it individually when the entire system is pushing us to eat, move, and accept this way, and also live the 2,000 daily choices we have to make that individually affect our health in the context of a greater world. It's hard to change that. It's not an individual choice that we can say, "I'm going to do this" and it's all going to be fine. We're a community and a group effort at a lot of things. That group mentality and normalcy are working against us.

Have you found that there are common threads here among your patients who have been successful in making big improvements in their health?

Yes, and they never do it alone. We talk about this in our clinic all the time. Bring somebody with you on that journey. If you don't have somebody with you, you need to find somebody with you, preferably many people with you. If you want to eat well and move often but yet you leave your work environment and go home to a family that doesn't eat well and doesn’t move often or you go to work every day and you're among people where it's normalized to sit and eat unhealthy foods, you're constantly immersed in that environment that's working against what you want to be.

The common thread when people are able to break through that is they've joined a group of people where their desired behavior is that normal behavior. It's easy to do that thing. We go back to James Clear all the time. He's one of my very favorite people about habit formation and systems changes. He's amazing the way he puts it. I am around a group of women at this point in my life on purpose that do yoga. It's very normal for me to do yoga and it's very abnormal if I don't do yoga. It feels very natural to do that.

Years ago, I didn't think I knew anybody who did yoga. If I wanted to do that, it would be odd. There would probably be people who would raise their eyebrows at me at that time of life and go, "You're going to do that thing?" Peer pressure is very real. I'm around people who go to the farmer's market, eat salads for lunch, and drink sparkling water. For me, doing those things is much easier to do because it's the normal thing to do.

You've created the lifestyle.

I've created that and it took work. There are people who don't do that in my life but there are a lot of people that do those things. It's easier. When patients do that, they create that or they have people around it so then that normalizes it.

Speaking from the role of a mother of two young boys, it's incredibly challenging to even get enough time with my girlfriends to say, "I do yoga with them," and things like that. From a personal perspective, with the first episode of this show at the beginning of the year, I shared how to achieve health goals, even if you are trying to do it a little bit on your own. I want to share this because it's important. You can create the community that you want to help achieve the health that you want but sometimes it's not practical to have them with you on the journey as much.

If you are to put a few tools in place, like creating a health log, be honest with yourself. Write down what your goals are and check in on a routine basis. It doesn't mean that you have to be seeing a metabolic doctor on a routine basis to walk towards something but it does start with documentation in some way. I went through and got the splurge of a smartwatch to help me on my health journey. I'm entering perimenopause. I'm still regular and everything like that but it's on the horizon. I wanted to be honest with myself on the daily.

The thing that I found with young children is it's far easier. Maybe I have pizza more often than I otherwise might. I had some of those chicken nuggets that came with frozen. I made them at home but I had some of them. Was I being honest about how much salt I was even consuming? This helps me because I'm logging my food on a device that's connected to my phone. I can go and make all those changes quickly.

On the days when I processed food, I was shocked at how much sodium I was taking in. I don't think people are even honest about this particular thing because you talk about things like hypertension. If you're consuming a lot of sodium, and it could even be like, “I had canned soup with bread that was buttered. Earlier in the day, I had a snack bar on the go,” there was that jerky I had but it was a little bit. All these things were a little bit.

Suddenly, you're retaining more water and maybe you didn't drink enough water to compensate for that so you're not flushing stuff out the same way and you end up carrying more weight. Some of that's water weight but it goes right into the next day. You have these stores still. Maybe you're more hungry because you're more thirsty and not giving yourself enough water. These things can compound.

Through the course of doing this for three weeks, from my perspective, I haven't eaten any less. I've most days eaten more because I'm like, “I'm running behind on my calories.” My body composition has changed pretty dramatically in three weeks. I don't want to give exact numbers here but I've lost about 7 pounds, which is good while retaining my muscle mass, which is hard and I'm putting on a little bit of muscle mass.

I'm also lifting heavy weights so that wasn't entirely surprising to me. To even maintain while losing weight is hard. Sometimes it takes a device or even a body composition scale to help you track those things along the way so you don't lose weight unhealthfully. Eating more, sometimes you're like, "I'm not that hungry but I haven't hit my macros." That's the thing I have to keep reminding myself. I need to get enough calories to be able to lose weight without going on this pendulum swing of weight loss and then weight gain.

That's a terrible scale to be on. That yo-yo is awful. When we watch body composition, that yo-yoing effect is terrible. It's so hard on the body.

It also makes it harder to achieve your health goals because your motivation starts to wane. There's something like, "I did all this work and then I weigh 5 pounds more but I did all this work. Why is it going like this?" It's going that way because you weren't able to stay consistent and you weren't nourishing your body enough.

One of those keys that I got into obesity medicine and started digging into pathophysiology is almost all the time when we have excess weight, we have something called insulin resistance. With insulin resistance, if you drop caloric intake and you don't have the normal metabolic flexibility that you're meant to have, which is a function of insulin resistance, the body will cannibalize muscles to create a substrate for energy. It will lower the metabolic rate. The body reacts very predictably. When that insulin resistance piece is flipped and then we starve ourselves, all of a sudden, we decrease our muscle mass and metabolic rate. It's very devastating. That's the body trying to find homeostasis.

With metabolic health, you've got to fix that insulin resistance piece, then you can lower the caloric rate. Your hunger hormones do not compensate and your metabolic rate doesn't decrease. It's a different method and a more long-term method to achieving weight loss than starvation. Starvation we know doesn't work. We keep trying it. The reason it doesn't work is in the presence of insulin resistance, it doesn't work. If we're trying to lose weight, it's usually because we have insulin resistance. It's this chicken or the egg problem. That's that metabolic health piece that matters so much.

The other question I have that relates to this is how much water people need to be getting. We're also not honest about this with ourselves. I drink beverages. Do they count too? My cup of coffee here could be a counter count. What are your thoughts on that?

If you look at various studies, there are all kinds of calculations you can do. I used to tell my patients, "Make sure you're peeing clear." Once you're peeing clear, you're usually well-hydrated. It's a good indication but not everybody wants to look at that. First thing in the morning, you're not. After you take a vitamin, you're not. There's all those little asterisks. Take at least eight glasses of water a day. You're going to get water out of your food. If you're eating a lot of whole foods, you're getting more water out of it than if you're eating ultra-processed foods. There are variables there. I try to get at least 64 ounces a day. I don't think you need to do gallons and gallons but if you're peeing clear, you're doing all right.

On a lot of these applications that you might use, they typically have water input too. What I find myself doing is anytime I'm logging food, I also log water, and that reminds me to drink more water. I find there are a couple of positive benefits from that. One is that I'm sleeping a little bit more soundly. While I might wake up in the middle of the night to go to the bathroom, it doesn't seem to affect how quickly I fall back to sleep. That part has been normal but part of that is I'm not as parched. Especially, in winter months and our heater's kicking on in the middle of the night sometimes or something like that. That can create dry air. That's a good point. It can also reduce how hungry you feel when you're getting enough water.

As we bridge away from this conversation focused on water, I'd love for you to talk a little bit more about how we're able to scale this. Moving from one person at a time, an individual issue, to something that we can more broadly change and move for people. We're all marching back towards health, slimming that waistline, having less visceral fat, having less of this myopic idea that, "Our health problems are our genes' faults." What do you see moving? What do you think we can do?

It's going to take multiple entities in multiple realms. A big part of it is a lot of our incentives are aligned away from that. That to me is the bigger problem. Most of us individually want to be healthier people. If you talk to anyone, they want to feel good, be vibrant, play with their children, live long, and interact in the world without feeling rundown. It's that gravity that pulls them back. We have to change things from a top-down and a bottom-up at the same time. The top-down piece is the hard piece. There are a lot of corporate interests and big businesses whose interests align with us staying unhealthy.

I don't want to say it's a conspiracy but look at the incentives. Some of our biggest industries in this country are big healthcare, big food, and big pharma. All of those profits off of people being sick are contributing to it. There are very few people who profit off of people being well. I don't know how you change those incentives from the top down. I know there are good people working on it in various realms. It will create a movement and there will be a tipping point but it's going to take a lot of work. Big food has a lot of pull. There's a lot of profit in you eating ultra-processed foods. Their profit margin is phenomenal. They want you to eat.

 

You get it in a box with a wrapper and it's going to be convenient. We've sacrificed healthcare convenience.

I get it. I love the convenience too but there are not a lot of people fighting from the broccoli growers of America to push that backwards. The big financial incentives in this country are aligned with subsidies for corn, soy, and wheat, things that make ultra-processed foods. If we change the subsidies, all of a sudden, we subsidize broccolis, peppers, eggs, chickens, fish, and all the other things. If those industries were subsidized and the cost of those products went way down, we could probably turn this around pretty quickly. I don't know how you change government. It's nothing I've been involved in.

There's a reason that people on the lower rung of our economic ladder tend to be fatter and less healthy. They tend to have a lower lifespan, a shorter overall lifespan as well, and a shorter health span because they're going to the less expensive foods, which tend to be more processed or much higher in fats and much lower in total nutrient content like micronutrients. It's harder to eat protein-rich also when you're in a lower economic status.

These things are common. You survive on beans, rice, tortillas, fried things, or onions. You're not feeding your body the same way. Convenient eating, I guess an apple is as convenient as some of these other things but I got to tell you, I go to buy an apple at the store, and first of all, they're pretty huge. They're the size of two fists because we've engineered them to be that big.

They're not quite apples anymore but they're still better than a bag of onions.

It's like a lot more than one serving typically. Do you eat the whole thing in one serving, cut it, and put it in the fridge? What do you do? The other part is it was $2 for an apple and that didn't use to be the case. To your point, it’s subsidizing things that are healthy, helping people understand what a serving is, and getting them to think about, "When am I full versus over full?"

Being comfortable in the kitchen, too. There are a lot of convenience foods that are more expensive than real foods in a lot of ways. I have patients that swing through McDonald's and it's a $7 meal, which doesn't seem that expensive but realistically you could go to the grocery store right behind you, get a rotisserie chicken, a package of frozen green beans, and an apple, and feed 4 people out of that for $10 or get 2 or 3 meals out of it. When you're not comfortable in the kitchen because it's become a generational issue that we don't know how to do that, it takes an additional step to think that through. There's a lot more to it than just cost.

I get a Costco order once a week with a lot of food in it. I have three teenage boys and they eat a lot of food. If I were to take them out or feed them from a convenience place, it would cost me a lot more than what it costs me to feed them through Costco. I also have the skillset of knowing I can cook on the grill fifteen chicken breasts at once. I can use an electric knife and cut them up into squares all at once. That all of a sudden becomes a great deal of meals in a hurry in my life, which I need.

That's a very practical approach. Think about buying some of these foods in bulk. You can get a lot of rice and beans. Instead of going to open something with a can opener, you spend a little bit of time in your kitchen. There are things that help us to create a more convenient lifestyle like air fryers and a rice cooker or instant pot as well so that you can combine these things in the morning and go off for the day. It's scheduled to start cooking when you need it. You get home and have this healthier meal that didn't cost you an arm and a leg either along the way, which took minimal prep time.

It could become very convenient. I was a single mom with three kids for many years working as a gynecologist. You can imagine my hours. Out of absolute necessity, I had to figure out crockpot meals and mass production of food. I was forced to learn it but it's a wonderful skill to have.

With you, I have the things that I buy at Costco but I also have built in a commitment to shop twice a week. I'm getting fresh produce twice a week. I do one middle of the week and one on the weekend. The weekend jaunt is to the farmer's market where I'm buying local produce without any packaging at all so it's not wrapped in cellophane or anything like that. I look at my midweek shopping venture as more of the pinch hit. What started to go or what do I need more of?

Also, the things that aren't available at my local farmer's market because they weren't in season here locally. Building in these small lifestyle pitches, suddenly, I've got healthy food that's fresh and that's prepared in my home for the most part. We eat out rarely. As I was having my cabinets refinished, I got takeout one night. I was surprised at how much it cost me in one stretch but then I was like, "This is lunches tomorrow."

I will tell you, there was a lot more salt in that food than I would typically put in my own, too. Greater intake of sodium, greater retention of water. That scale might move on the day if I chose to get on it every day. This gets back to another habit that I like to encourage people to do, which is not weighing themselves every single day.

I was going to say that. I can't agree with daily weighing. It's destructive because it isn't a good measure of what is it that's changing. It's often water weight that's changing and that's irrelevant in terms of health. Unless you have severe hypertension, renal failure, or congestive heart failure where that extra water weight is detrimental. For most of us, it's water.

Daily weighing is terribly destructive because it isn't a good measure of what is changing.

I had a salty meal last night because of the construction project and I know that that would change. It would be demotivating if I got on the scale and saw that. Therefore, take a step back. For me it's Saturday mornings so after the finish of the week, I weigh myself, do the body comp scale, log it all, and see the movement. It's going in the direction I want it to, which is great. It's reinforcing therefore the habits that I'm instilling every day.

Body composition is essential. We do it in our clinic in Kansas every month on every patient and it goes into a spreadsheet. I've discouraged people when I've said, "Don't get excited about that 5-pound weight loss. That's water." I don't care. Clinically, that means nothing to me that you're down 5 pounds of water. If you're up 1 pound of body fat, I care a lot more about that. It's trying to retrain people to look at what is it that's changing.

There was a Netflix documentary that shared with the world a twin study where they put half of the twins so one of each would be on a vegan diet that was more healthy and the other would be on a healthy omnivore diet. I don't know if you've had the opportunity to see this yet.

I haven't yet. One of my family members has sent me a little, "You should watch this." I don't watch much television at all so it'll probably be a bit before I see it.

I get it. I looked at it as homework. I'm going to summarize quickly for people. You would anticipate that with the vegan diet, people may have lost more weight and potentially even lost more muscle but because their diets were so healthfully architected with total calories and macros and mind, what they found universally between the twins was that the people who were on the vegan diet lost more total visceral body fat than the group that was on the omnivore diet, even though they were on comparable nutrients levels and both eating healthy diets.

What's the primary difference there? Perhaps more saturated fat, a little bit more calorie density, and more meat protein, which resulted in a slight difference in this capacity. Depending on how committed these twins were to the lifestyle, some of them did better than others. Outlook also had something to do with their success. That was interesting because I had thought that the vegetarian-vegan group was potentially going to lose more muscle mass and that didn't prove out.

I'm fairly agnostic in terms of vegan, vegetarian, keto, paleo, and all the different things. The key for all of them is whole foods. If any diet is made up primarily of whole unprocessed foods, it’s going to have pretty good health outcomes. There are going to be tweaks there. Stanford study said that most of the meat in this country is very ultra-processed. I didn't look at how much, "Are they eating processed meats? Are they eating grass-fed beef?"

If you were eating a paleo diet made up of grass-fed beef, free-range chickens, free-range eggs, and wild-caught salmon, the health benefits are probably phenomenal. If it's USDA beef, grain-fed beef, processed pork, antibiotic-fed chickens, and these terrible eggs that have almost pale yellow yolks, they're not a great healthy protein to start with. It's still better than an ultra-processed food diet. It depends.

What was interesting about this particular study in the Netflix documentary is that they monitored and gave them like, "This is the meal. This is all the food you're going to eat." It’s like a meal kit delivery for the course of the week at the beginning of the study. However, they translated it to, "You go, do the shopping, and put it into practice." That's the less regimented. I imagine that the health of the meat sources they were getting probably shifted a bit because people make decisions based on price. The organic chicken is this much. The non-organic chicken is this much. The same thing with eggs. I pay for a dozen eggs close to $10 but most people are paying closer to $5. It does vary.

I also eat omnivore food. I made the choice to go regenerative organic so I'm buying meats and bulk that are shipped to me from regenerative organic farms. That costs a little bit more but at the same time, when I'm cooking meat for my family, I have more faith in its quality. It's not just like another cut type of delivery of more corn, soy, wheat, glyphosate, pollution, and concentrated animal feeding operation support that I don't want.

I always tell my patients, "You are what you eat but you're also what your food eats." If your food's eating roundup and corn pellets, then you're essentially eating roundup and corn pellets. It’s sad.

You are what you eat, but you're also what your food eats.

It's terrifying and hard to keep all of that out. The message here is, "Get into the kitchen and try to be mindful of your sources of food."

Do the best you can. I have a small urban farm in Kansas. It’s funny because I grew up in the middle of the city. I had chickens for a long time. Their eggs were phenomenal but it was so much work. I was like, "I'm going to go buy these eggs at the farmer's market." It's not worth the upkeep that it requires to keep chickens and keep the predators away from chickens. When it's below zero, keep the heater going and the chicken coop. It became more work than it was worth.

Unless you love it.

I do grow a lot of my food because that's fairly easy but it's a lot of work. There's a lot of nuances there. It's not simple. In our clinic, we have a lot of people who come in saying, "I'm trying to be a vegetarian or a vegan." It's hard. What we find is most of them, we call them carbetarians. They're a processed food carb overloading diet and it's unhealthy. I'd rather get them on a more balanced diet to get that protein level up, even if it's not a perfect protein. There's no perfect answer unless you live in a world where you can get all that wonderful protein and access the farmer's market all the time. It's hard.

There are also solutions. I can buy rice and regenerative beans, store them in a dry state, soak them, and cook them as needed. That's an inexpensive way to get enough protein and have it be plant-sourced and more locally sourced as well because there are some regenerative farms here in California that I can go to for the beans and grains. It's harder to get to maybe a little more expensive. It’s not something I can just buy off the grocery store shelf for the most part. It takes a little extra effort but it's all about how much you want to put in and what's going to work for you and your family.

Also, where your priorities lie. Life is busy. I get it. Most of us have a limited amount of time. Most of us spend several hours of our day staring at a screen, not because it puts money in our pocketbook though. It's because it's joyful and pleasant. If we allocate some of that time to food preparation, we also have to prioritize it and then be comfortable with it. If it's going to take away our precious time and energy, we're uncomfortable doing it, and the people around us don't want us to do it, that's hit after hit.

If the kids are going to whine and cry about this because they want frozen chicken nuggets, at the end of the day, you're probably going to cave because it's your extra time and effort, and then it's an emotional battle. Your relationship is going to be strained because of it. There's a lot working against us but the more we do it, the more it becomes normal and easier. The more you do something, the easier it gets.

 

My children have fought against me in our dietary patterns for a very long time and it is what it is. As they start driving, I say, "You can take your hard-earned money and go buy that stuff. I'm not going to say you cannot but at the end of the day, you're going to come home and it's going to be free to eat the healthy food here." I'm going to win some of the time, not all the time.

Eventually, they'll come back to these habits. That's what you see with people.

I keep hoping that that feels normalized to them.

All children in the early phase go through this carb-loving perspective where all they want to eat is fried, white, and not very nutritious. I still commit to making the food that the whole family is going to eat and I serve it. It's like, "If you're hungry, you're going to eat it."

If you're not hungry until tomorrow, you're going to eat the next one.

I don't want to call this a fat or a craze but it's seeming almost that way. Many people are going to something like Ozempic or other newer anti-obesity medications that have exploded in popularity as one of the ways to treat this health epidemic we have of obesity and metabolic dishealth. Do you use them in your clinic? What is your perspective?

I do. As an obesity medicine clinic, we've always said these are wonderful tools to have. We have very little coverage for the newer anti-obesity medications in the Midwest. It's very difficult to find an employer that's covering them so those have been almost out of reach for many of our patients. We've used the older anti-obesity medications for a long time, not in the same way that the narrative has taken off. We've always looked at it. Just because we're working on metabolic health, we work on this idea that you have to get that metabolic flexibility back.

Doing that as a multi-step process, these anti-obesity medications do two things. Not at the same degree for every person. There are a lot of nuances there but they do decrease the physical hunger hormones that make you physically want to eat. They then decrease the food noise piece. The food noise is a result of that metabolic dysfunction. It's that constant, "I want food. It's there. There are donuts in the break room. I like donuts in the break room. I could have a donut. It's just one." It’s that mental chatter that many of us have around food.

 

These medications can be useful in quieting those things so that we can do the things that need to be done to get that metabolic flexibility and insulin resistance back. That's deploying the whole foods and the essential protein and getting rid of those ultra-processed foods that worsen the underlying problem. We've used them for a long time of, "Let's put these medicines on board so we can do the real work." There are people who put those medicines on board and go, "The food noise is gone and I'm not hungry so I don't have to do that work." Those are hard.

Those are patients we struggle with because why do that hard work when you're not hungry anymore? The problem is when the work doesn't get done and that space is there, eventually, biology kicks in. The hunger hormones come back. The newer medicines hold them back longer, which is lovely but if you stop the medicines or hit that ceiling, then those hunger hormones start to come back. If that underlying problem is not fixed, those hunger hormones are back, you're hungry, and the food noise comes back, and then you're back to square one.

We look at them as wonderful tools to get the hard work done, not just to quiet the noise and get rid of the hunger hormones temporarily. It's a different way of looking at it. It's not very sexy but it's very efficacious long-term for a lot of people when they do it that way. They're there. What we do see all the time and the reason we're adamant about body composition analysis is when you have insulin resistance and you drop the caloric load, the body goes and cannibalizes muscles to get a fuel source. If we watch that body composition shifting for the worse, if we all of a sudden are losing lean mass, we're not losing fat mass, that's a huge red flag to me that we are not eating the way we should be eating while we're on these medications.

Much to our patients' dismay, a lot of times, we take them away. I don't want to be a part of someone losing muscle mass as they age. It seems like a terrible thing to latch onto as a physician. I don't want to create sarcopenia and frailty as we age because we're being a part of cannibalizing that muscle mass. It's that science of obesity medicine, metabolic medicine versus taking a drug from your med spa.

Sarcopenia, just so people are not confused by this term, is the medical term for age-related muscle loss.

It's not having enough muscle mass for the body you're carrying, for the bones, the organs, and the fat mass. We have what we call sarcopenic obesity where we have excess weight but it's disproportionately adipose tissue compared to the muscle mass. Those patients are very sick. We need to have muscle mass to carry the body.

One of the most important health tests that older adults have is the sit test. Can they sit by themselves without having to hold onto something and get back up? That sounds simple to people but the reality is that when we're in our late years, like if you're lucky enough to make it to 90 or 95, that is one of the most important indicators of your overall health.

Also, your grip strength, if you still have muscle mass in your hands to grab things. They're reflections of overall muscle mass. It's important because once you miss a step or you trip over the cat toy on the floor, if you don't have the muscle mass, the fast twitch, and the slow twitch fibers that allow you to grab your body weight and restabilize it quickly, you fall. We know that falls are devastating as we age, not because we fall and break our head or hip. We do but we don't have the muscle mass to recover and rehabilitate ourselves from those injuries. We get immobilized from an injury and our muscle mass steeply declines. It wasn't good to begin with. It's a very quick downhill spiral for a lot of us as we age. That muscle organ is amazing. It's essential.

 

That helps people have that rounder perspective. It sounds to me like you look at these drugs as almost like a spot treatment. You use it while you need it.

Ideally. The studies don't show that but all the studies are funded by the pharma companies selling the drugs so they're not going to study them in like, "Let's pull them off." That's up to us with boots on the ground as clinicians to say, "Can we pull them off?" In any intervention, you may not be able to. You get somebody's acne under control with medications. You want to try to pull those medications away over time. The acne's gone, they've learned the skincare techniques, and they've changed their diet to get rid of the foods that are causing the acne, can you start to pull it away? Maybe not. There may be some people who have such advanced diseases that they can't pull them away.

If we're using them for the right reason, we should be able to wean people off with the idea that life might happen and we might have to restart them 4 or 5 years later because the environment might have changed. They might be in a new place with a new environment. All those controls that they've put in place have deteriorated. We might need to relapse, regroup, and stay on it. It is a chronic disease that wants to come back.

If we think about it, these are tools. It's not the only tool. There are probably other ways to help an individual get there if they don't need that level of support. Are there particular supplements that you lean to for your patients in general? I'm curious about how you see things like probiotics or omega-3s as it stands with Orlo. That's something that we do.

When our patients come in as a first visit, there are times we take it away, but we usually recommend some multivitamins because I don't know where they're getting their vegetables or foods and if the soil's good quality. We recommend omega-3s at least 1,000 milligrams a day. We recommend a probiotic. We recommend vitamin D with these long dark winters. Almost everyone I've ever checked is vitamin D deficient and we know that's worse in patients with obesity so it's fairly universal. Some of our patients will put on chromium because that helps with insulin resistance. It's not well-studied because no supplements are that well-studied but it seems like a good idea. That's our initial cocktail.

I would like all my patients to get their omega-3s and probiotics from their food. I would like them to get their vitamin D from the sunshine. I would like all of that to happen but at the initial onset, trying to fix any deficiencies is very important to me and also to stay on that through that acute phase of weight loss when they may not be getting all the nutrients they need. They're all important. There's probably more but I hate handing people a whole bucket of pills and saying, "Let's overwhelm you with this." I got it down to like, "What are the ones that I want the most?"

I'm with you on that too because I've been in the field of health and nutrition, specifically in supplements for many years. I have to say that the basics for me are in omega-3. I'm in the omega-3 industry at this point for a reason. This is probably one of the most studied areas of health when it comes to supplementation. Omega-3s and multivitamins win.

Probiotics win a lot. Probiotics are getting there.

Sometimes the research is a little overblown as it relates to specific strains of probiotics. It's also funded by companies so you'll have to take it with a grain of salt.

Yes, take everything with a grain of salt.

Getting the omega-3s in a way where you're not going to burp them up where your patient compliance will be good. With Orlo, we're doing them in the polar lipid form so they're up to three times better absorbed and they also don't burp back on you fishy. Audience of this show, you can use the code NWC10 to get an extra 10% off it at checkout. That includes subscriptions, too. We're running some cool promos so check those out.

Vitamin D, I want to share with you a couple of things I've learned over the years because it'll also be helpful for our audience. I am of Mediterranean descent. If you're watching this on screen, I look rather White. I have blonde hair and white skin. You'd think that I'd be able to construct enough vitamin D if I'm not wearing sunscreen and I'm spending time in the sun in the summer months. It’s not true. Part of that has to do with my genetics.

I'm not as good at making vitamin D from the sun. Even if I take my levels at the end of summer, which I've done and I only wear sunscreen gently speaking on my face, and I'm out there in a bikini on the beaches of Hawaii for some of that summer, my stores are still under 30. That UL per DL or something like that, you want to see it over 30 and I'm not there.

I supplement. I make sure that I get between 1,000 and 2,000 IU of vitamin D each day. I'm doing that with Orlo Nutrition's Immunity Boost because vitamin D is one of the things in there but there are other ways to do it in your diet. This is a trick I learned. You can take mushrooms, any mushroom that you have that you're cooking with or that you're using in your food, and expose them to light for about half an hour before you use them.

If you put them out in the sun, even on your counter, or on the window sill, get them out in the invisible light for 15 minutes to 30 minutes. When you cook with them, their stores of vitamin D have more than doubled. It is a way to get more nutrition from the food that you're already buying and getting. There aren't very many sources. It’s another place to get food sources, like if you're doing cod livers but how many people are going to go to cod livers or olive oil?

Usually, it's a supplement. They make tiny soft gels you can get for rather inexpensive if that's easier for you. Generally speaking, I've learned that I need on average about 1,000 to 2,000 IU of vitamin D a day to keep my stores where I want them. That's different for everybody. Typically, in your physical, you can get this checked. I'd always recommend you check, don't guess. The same applies to omega-3s. You can check and see where you're at.

We're running a campaign with Orlo where we're covering the costs of Omega quants third-party blood test, where you do a blood spot test. You can verify your levels of Omega-3, supplement for 3 or 4 months, and then recheck. If you're interested in that, check out the Tested By You program on OrloNutrition.com. I like to leave our audience with some actionable tips at the end of every episode. We're at that point. What recommendations would you make that you think are broadly going to help people on their health journeys that they could implement especially if they haven't taken the first step?

It comes down to whole foods. The closer you can eat to the way we are designed to eat is beneficial. Also, working on systems and habits, not outcomes. "What little things can I do that over time will compound into a healthier outcome?" Instead of working backward from this big audacious goal, say, "What could I do today? If I add a salad to my lunch every day and I do that 5 days a week for the next 10 years, that's going to have a huge impact on my long-term health." Focus on the little steps because the little steps compound a lot better than trying to hone in on the end and work backward.

Focus on the little steps because the little steps compound a lot better than trying to moon in on the end and work backward.

I'm looking at my macros. It’s 40% of my calories from protein ideally or I'm more like 30-30 so 30% protein, 30% fat, and then 40% carbohydrates. If I'm tracking that, an app for me is the only way I can do that because I don't know how many grams of these things are in the foods. You can use a free app. MyFitnessPal is a free app. If you have a Fitbit, you can use a Fitbit app. I have Samsung Health so I can use that. I can go ahead, log the foods that I'm eating, and keep a general idea of what my nutrient spread is. Otherwise, I don't need enough protein and fiber, and I get too much salt. I don't think salt is a villain but it tends to be an indicator of leaning on processed foods more.

That's not the salt that you sprinkle on your broccoli that's the problem. It's the salt that you don't even know you're eating that's the problem.

It tends to be an indicator of, "I ate too many processed foods." I see the same thing happen with saturated fat. These apps will auto-calculate that. I will find that I, unbeknownst to me, ate way more saturated fat in a given day because I ate processed foods. It's probably not the healthiest.

It's not the cheese you're eating by itself. It's the stuff that's hidden in there that you don't think much about.

That's why I love where technology has taken us. Whatever you're doing, you probably have a smartphone. You can have access to one of these healthy apps. Put it on your phone, start logging, and see where you are. If you know where you are now, then you can plan for tomorrow and the next day. It makes small changes that are going to make a big difference with time. Maybe we aren't 100% what we eat but we are what we absorb. If we get the right nutrition, we feel better and we notice, "I did these three things today and I feel this much better." Maybe you're more likely to keep those habits going.

You can't manage what you don't measure. It comes down to that.

Thank you so much for this time. I've so enjoyed this conversation. You are a wealth of knowledge and an incredible asset, especially to the people of Kansas. I want to say overall, if people want to get in touch with you and what you're doing, how would you like them to reach out? What works best for you?

It’s probably on our company's website which is HeartlandWeightLoss.com. We're also on Facebook, we're Heartland Weight there because it's too long to get the whole thing on there. I'm on LinkedIn. I do a lot of things on LinkedIn. Journeys Metabolic is my new company where we're trying to scale this in a digital format so JourneysMetabolic.com. There are lots of things to learn.

As far as this ongoing conversation goes, I would love to invite you back to touch on these topics again and stay connected here. This is going to be valued content for our audience. Thank you so much.

I love talking about it. Thank you very much.

‐‐‐

To find out more about Dr. Courtney Younglove and the work that she's doing, please visit JourneysMetabolic.com, which is the new company that she's working with, and also HeartlandWeightLoss.com. The resources they provide there will help you stay on track with your health goals. As we round out this episode, I want to remind you that we are here to support your journey.

If you have ideas or thoughts for episodes that we should host in the future, please feel free to reach out. If you enjoyed this episode, I hope that you'll subscribe and leave us a review, a comment, or even share this with your audience. Each of these actions can help us to reach more people and improve more individual's health. As I close this episode, I hope you'll join me by raising a cup of your favorite beverage as I say my closing words, here's to your health.

 

Important Links

• Heartland Weight Loss
• Journey's Metabolic
• Well Me
• Achieving Your Health Goals In 2024 - Past Episode
• Orlo Nutrition's Immunity Boost
• MyFitnessPal
• Fitbit
• Samsung Health
• Heartland Weight - Facebook
• LinkedIn – Courtney Younglove
• Instagram - Heartland Weight Loss
• YouTube – Heartland Weight Loss

 

About Dr. Courtney Younglove

Courtney Younglove is a physician, board-certified in Obesity Medicine and Obstetrics & Gynecology. She has been practicing clinical medicine for almost 25 years. She earned her fellowship from the Obesity Medicine Association in 2021 - one of the highest honors bestowed upon members who demonstrate dedication and commitment to the clinical treatment of obesity and obesity-related diseases.

Dr. Younglove is incredibly passionate about making evidence-based treatments accessible to all patients who struggle with the disease of obesity as a means to improve health and decrease healthcare costs. Dr. Younglove is the founder and medical director of Heartland Weight Loss, an insurance-based Obesity Medicine practice with clinics in Overland Park, Kansas, and Lawrence, Kansas.

She is the Chief Medical Officer of Journeys Metabolic, a solution for tackling our metabolic health crisis at scale and she is also the founder of WellMi, a point solution bringing Obesity Medicine directly to employers.